The overall goal of this project is to streamline the new advanced ultrasound imaging (USI) and magnetic resonance imaging (MRI) of carotid plaque for effective stroke risk tratification. Rupture of carotid plaque causes stroke posing threats to human life and long-term disability. Recent investigations have shown us that specific features of atherosclerotic plaques predispose them to plaque rupture, the proximate cause of clinical events. Magnetic resonance imaging (MRI) has been the gold standard for carotid plaque characterization. Latest ultrasound imaging (USI) technology makes it possible to contribute more to plaque characterization, yet it lacks of validation. The objective of this proposed effort is to extend the MRI high-risk plaque characterization technology and knowledge to validate the performance of USI plaque characterization and to compare and improve the performance of both MRI and USI with the information and knowledge from the other modality. In Phase I a tool to register MRI and USI data for comparison will be developed. Algorithms for USI plaque characterization will be investigated. Preliminary comparison of plaque characterization on the 30 cases between MRI and URI will be conducted to explore the feasibility of the streamlined risk stratification. Success of Phase I will establish the foundation for Phase II and beyond where an FDA cleared multi-modality software for streamlined MRI and USI high-risk plaque characterization will be commercialized, and evidence-based multi-modality defense lines with USI and MRI will be developed for the effective stroke risk stratification at reduced healthcare cost by taking full advantage of both MRI and USI. PUBLIC HEALTH RELEVANCE: Carotid plaque characterization helps risk stratification of cardiovascular disease (i.e. heart attacks and strokes) in this aging society. New tools are needed for better assessment, lower cost and broader availability. The new tool proposed in this investigation will streamline the ultrasound imaging (USI) and magnetic resonance imaging (USI) in plaque characterization by fully taking advantage of both modalities. It is an approach more cost effective and personalized. The tool will also provide a unified interface to fuse MRI and USI plaque characterization and risk stratification for advanced research.